Prevalence Of Cerebral Microbleeds Research Articles

Microbleeds in the Corpus Callosum in Anoxic Brain Injury.

PurposeThis study was performed to evaluate the relationship between callosal microbleeds and anoxic brain injury.Materials and MethodsTwenty-seven patients with anoxic brain injuries were analyzed and retrospectively compared to the control group of patients without a history of anoxic brain injury using Fisher's exact test regarding comorbidities and cerebral microbleeds. The patient group was subdivided according to the presence of callosal microbleeds. Fisher's exact test was used to compare the presence of typical MRI findings of anoxic brain injury, use of cardiopulmonary resuscitation, and prognosis. The Mann-Whitney U test was used to compare the interval between the occurrence of anoxic brain injury to MRI acquisition.ResultsThe prevalence of cerebral microbleeds in the patient group was 29.6%, which was significantly higher than that in the control group at 3.7% (p = 0.012). All cerebral microbleeds in the patient group were in the corpus callosum. Compared with the callosal microbleed-absent group, the callosal microbleed-present group showed a tendency of good prognosis (6/8 vs. 11/19), fewer typical MRI findings of anoxic brain injury (2/8 vs. 10/19), and more cardiopulmonary resuscitation (6/8 vs. 12/19), although these differences did not reach statistical significance (p = 0.35, p = 0.19, and p = 0.45, respectively).ConclusionCallosal microbleeds may be an adjunctive MRI marker for anoxic brain injury.

Differential Distribution of Cerebral Microbleeds in Subtypes of Acute Ischemic Minor Stroke and TIA as well as its Association with Vascular Risk Factors

Cerebral microbleed (CMB) is a novel neuroimaging marker of cerebral small vessel disease. To determine the prevalence of CMB in the subtypes of acute ischemic minor stroke (AIS) and transient ischemic attack (TIA) and to identify the risk factors associated with location and number of CMB. Patients with AIS (National Institute of Health Stroke Scale of 5 or less) or TIA were included. CMB was characterized using the Microbleed Anatomical Rating Scale (MARS). Of the 488 subjects [mean age (standard deviation): 57.5 years (14.4 years), males (77.7%)] recruited, CMB was noted in 140 (28.7%). About 35% with CMB had a lacunar stroke etiology, whereas LAA and CE subtype constituted 33.6 and 10.7%, respectively (P = 0.000). Lacunar subtype was more likely to harbor multiple CMB (four or more) and CMB in all locations (lobar, deep or infratentorial). On multivariate analysis, systemic hypertension [P = 0.025; odds ratio (OR) 0.33 (95% confidence interval (CI) 0.129-0.874)], serum triglyceride (TG) levels below 150 mg/dL [P = 0.001; OR 3.70 (95% CI 1.698-8.072)], and presence of white matter hyperintensities on magnetic resonance imaging brain [P = 0.026; OR 2.18 (95% CI 1.096-4.337)] were associated with the presence of CMB. Those with serum TG levels of less than 150 mg/dL were more likely to harbor lobar (P = 0.002) or infratentorial CMB (P = 0.022), whereas those with serum creatinine levels of more than1.5 mg/dL have lobar CMB (P = 0.033). Our study showed a differential distribution of CMB in ischemic stroke subtypes and association of risk factors with the presence, number and location of CMB.

Coexistence of Cerebral Microbleeds and Amyloid Pathology in Patients with Cognitive Complaints.

Background and PurposeWe investigated the prevalence of amyloid positivity and cerebral microbleeds (CMBs) in subjects with cognitive complaints with the aim of identifying differences in clinical parameters and cognitive function according to the pattern of coexistence.MethodsWe retrospectively enrolled 200 subjects with memory impairment and applied both standardized 18F-florbetaben PET and brain MRI, including susceptibility-weighted imaging. The amyloid burden was visually classified as positive or negative, and the number and location of CMBs were also analyzed visually. Descriptive analysis was performed for the prevalence of amyloid positivity and CMBs. The relationship between the coexisting pattern of those two findings and clinical parameters including the results of neuropsychiatric tests was analyzed.ResultsPositive amyloid PET scans were exhibited by 102 (51.5%) of the 200 patients, and 51 (25.5%) of them had CMBs, which were mostly located in lobar areas in the patients with positive amyloid scans. The patients with CMBs were older and had a higher burden of white-matter hyperintensities than the patients without CMBs. The patients with CMBs also performed worse in confrontation naming and frontal/executive function. When classified by topographical region, parietal CMBs (odds ratio=3.739, p=0.024) were significantly associated with amyloid positivity.ConclusionsThe prevalence of CMBs was higher in patients with cognitive decline than in the general population. CMBs play distinctive roles in affecting clinical parameters and neuropsychological profiles according to the coexistence of amyloid pathology.

Prevalence of and Risk Factors for Cerebral Microbleeds in Moyamoya Disease and Syndrome in the American Population

Background and Purpose: Cerebral microbleeds (CMB) are reported to be frequent in moyamoya disease (MMD) and moyamoya syndrome (MMS) in the Asian population. It is associated with an increased risk of intracerebral hemorrhage. The significance of CMB in MMD/MMS in non-Asian populations has not been well established. Our study aimed to investigate the prevalence of CMB in MMD/MMS in a moymoya cohort with a majority of non-Asians and to identify risk factors for developing a CMB and its predictive value for subsequent vascular events. Methods: The moyamoya database was compiled by screening for MMD/MMS among patients admitted to the Zale-Lipshy University Hospital at the University of Texas Southwestern Medical Center. We identified and analyzed data of 67 patients with MMD or MMS. Patients were characterized as CMB+ or CMB– based on MRI findings. In CMB+ patients, the total number and location of CMB were identified. Univariate and multivariate logistic regression were used to identify risk factors for developing CMB and whether CMB are associated with the development of subsequent vascular events. Results: Out of a total of 67 patients, 11 (16%) had CMB. Males had significantly higher odds of having CMB as compared to females (OR 1.76; 95% CI 1.40–24.3, p = 0.021). The incidence of CMB was also associated with age at diagnosis (mean age of CMB+ patients vs. CMB– patients: 44 vs. 34 years, respectively, p = 0.024), smoking (p = 0.006), and hemorrhagic stroke at presentation (p = 0.034). Logistic regression with multivariate analysis found that gender and age at diagnosis remained statistically significant. New ischemic events occurred in 2 (20%) out of 10 CMB+ patients and 13 (23%) out of 55 CMB– patients, respectively (p = 0.79). While 2 (3%) CMB– patients had a new cerebral hemorrhage during follow-up, none of the CMB+ patients did. Conclusions: CMB are less prevalent in MMD/MMS in the USA than in Asia. An older age at diagnosis and male gender were associated with CMB. The presence of CMB was not associated with an increased risk of a subsequent ischemic or hemorrhagic stroke.

Abnormalities of brain imaging in patients after left ventricular assist device support following explantation

The potential impact of long-term left ventricular assist device (LVAD) support on the brain remains unclear. This study aimed to investigate cerebral microvascular damage in patients after long-term LVAD implantation using magnetic resonance imaging (MRI). We reviewed the medical records of patients after continuous-flow LVAD implantation in our hospital from 2006 to 2016, who underwent brain MRI after LVAD explantation for either transplantation or recovery. Age- and sex-matched healthy controls and patients with chronic heart failure (CHF) were collected from our pooled MRI database. The presence of cerebral microbleeds (CMBs) and cortical superficial siderosis and the severity of white matter hyperintensity (WMH) and cerebral atrophy were compared between patients with prior LVAD and 2 control groups. This study included 49 patients with prior LVAD, 49 healthy controls, and 45 patients with CHF. CMBs and cortical superficial siderosis were detected in 98% (p < 0.001) and 31% (p < 0.001) of patients with prior LVAD, respectively. The number of CMBs was higher in patients with prior LVAD than in the 2 control groups. The severity of the WMH was higher in patients with prior LVAD than in healthy controls but similar to that in patients with CHF. Quantitative analyses of cerebral atrophy revealed a significantly higher bicaudate ratio and cella media index in patients with prior LVAD than in the 2 control groups. Patients after long-term LVAD support showed a higher prevalence of CMBs and cortical superficial siderosis and more severe cerebral atrophy than did controls. These findings may indicate cerebral microvascular damages in long-term LVAD support patients.

Use of anticoagulant therapy and cerebral microbleeds: a systematic review and meta-analysis.

Anticoagulant therapy increases the risk that cerebral microbleeds (CMBs) progress to intracerebral hemorrhage, but whether the therapy increases risk of CMB occurrence is unclear. We performed a systematic review and meta-analysis to investigate the potential association between anticoagulant use and CMB occurrence in stroke and stroke-free individuals. We searched observational studies in PubMed, Ovid EMBASE, and Cochrane Library from their inception until September 2019. We calculated the pooled odds ratio (OR) and 95% confidence interval (CI) for the prevalence and incidence of CMBs in anticoagulant users relative to non-anticoagulant users. Forty-seven studies with 25,245 participants were included. The pooled analysis showed that anticoagulant use was associated with CMB prevalence (OR 1.54, 95% CI 1.26-1.88). The association was observed in subgroups stratified by type of participants: stroke-free, OR 1.86, 95% CI 1.25-2.77; ischemic stroke/transient ischemic attack, OR 1.33, 95% CI 1.06-1.67; and intracerebral hemorrhage, OR 2.26, 95% CI 1.06-4.83. Anticoagulant use was associated with increased prevalence of strictly lobar CMBs (OR 1.68, 95% CI 1.22-2.32) but not deep/infratentorial CMBs. Warfarin was associated with increased CMB prevalence (OR 1.64, 95% CI 1.23-2.18), but novel oral anticoagulants were not. Anticoagulant users showed higher incidence of CMBs during long-term follow-up (OR 1.72, 95% CI 1.22-2.44). Anticoagulant use is associated with higher prevalence and incidence of CMBs. This association appears to depend on location of CMBs and type of anticoagulants. More longitudinal investigations with adjustment for confounders are required to establish the causality.

Prevalence of cerebral microbleeds and other cardiovascular risk factors in elderly patients with acute ischemic stroke

BackgroundCerebral microbleeds are small, round dark-signal foci in the T2*-weighted magnetic resonance imaging. They are encountered in cerebral amyloid angiopathy and hypertensive vasculopathy. Their prevalence is common in ischemic stroke and cerebral hemorrhage. The purpose of this study is to investigate the prevalence of CMBs and associated risk factors in the elderly patients with acute ischemic stroke.ResultsCerebral microbleeds were significantly associated with the presence of hypertension (in the subgroup of recurrent stroke) and with hypercholesterolemia. There was a significant association between the number of the microbleeds and severity of white matter lesions as a higher number of microbleeds related to more severe white matter lesions. The microbleeds were more prevalent in the group of patients using antithrombotics.ConclusionAge, hypercholesterolemia, and the use of antithrombotics emerged as the most important associated risk factors for the presence of CMBs. On MRI, there was a significant association between the number of CMBs and severity of white matter lesions as a higher number of CMBs related to more severe white matter lesions.

Cerebral microbleeds prevalence and risk factors from UK biobank with 3.0 T SWI sequence

To identify CMBs' prevalence and its risk factors assessed by informed criteria in a large population-based individuals from UK Biobank. 9066 subjects at mean age of 55.5 years (SD 7.4 years) were recruited. Brain susceptibility weighted imaging(SWI) data were acquired from 3.0 T scanner. 223 subjects with incomplete or bad imaging quality were excluded. Age, follow-up years, sex, education, stroke, intracerebral hemorrhage, myocardial infarction, diabetes, ever-smoke, blood pressure, body mass index(BMI), medication use, physical activity, APOE4 status and diet preference were included. The Microbleed Anatomical Rating Scale(MARS) was used to assess CMBs.We used unpaired two-samples Welch's t-test for continuous variables and Mann-Whitney test for ranked variables. Two multiple generalized linear models were evaluated: model 1, each risk factor with age, gender and follow-up years taken into account; model 2, statistically significant risk factors from model 1 to be reentered. All statistical analyses were performed using R. 8160 subjects were included (47.27% male). CMBs prevalence was 7.01%, mostly lobar(439 subjects). Adults with CMB were older, less educated, with higher hypertensive status, less BMI and more APOE4 positive presence. The model 2 showed that age, higer BMI and APOE4 were significantly associated with overall CMBs presence; BMI and APOE4 were independently related with lobar CMBs; Blood pressure and ever-smoke were associated with deep group; Dyslipidemia and lamb take were independent predictors of infratentorial CMBs. Each CMBs subgroup has its separate risk factors. More attention should be paid for earlier prevention of CMBs.

Increased prevalence of cerebral microbleeds in patients with low left ventricular systolic function.

Gradient-echo T2-star (T2*)-weighted magnetic resonance imaging (MRI) is a sensitive method to detect cerebral microbleeds (CMBs). The presence of CMBs was reported to be a marker of future cardiovascular mortality and is associated with various cardiovascular risk factors, use of antithrombotic drugs, and cognitive dysfunction. However, the relationship between cardiac function and CMBs remains unclear. We investigated the association between cardiac function and presence of CMBs in patients with cardiovascular diseases. This single-center retrospective study included a total of 424 participants (mean age 70 ± 12years; men 286 (67%); mean left ventricular ejection fraction (LVEF) 61% ± 12%] who underwent echocardiography and brain T2*-weighted MRI within 1 month without neurologic abnormality. CMBs were found in 118 (28%) patients. There was no significant relationship between CMBs and anticoagulant or antiplatelet therapy. LVEF was significantly lower in patients with CMBs than in those without CMBs (59% ± 13% vs. 62% ± 11%, P < 0.05). On multivariate logistic analysis, lower LVEF [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.96-1.00; P < 0.05] and age (OR 1.02, 95% CI 1.00-1.05; P < 0.05) were significantly associated with CMBs. The presence of CMBs was frequently observed in the patients with cardiovascular disease and was significantly associated with age and LVEF.

An investigation on prevalence and severity of cerebral microbleeds in patients with different stroke classifications of cerebral infarction

Objective To investigate the prevalence and severity of cerebral microbleeds(CMBs) in patients with different stroke classifications of cerebral infarction. Methods From October 2016 to December 2017, the clinical data of patients with acute cerebral infarction in the Second Affiliated Hospital of Xuzhou Medical University were collected through the prospective study.The SWI technique was used to screen the CMBs.According to the TOAST and OCSP classifications, the prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction were analyzed. Results A total of 254 patients with cerebral infarction were enrolled, there were 136 patients(53.54%) in CMBs group and 118 patients(46.46%) in no CMBs group.The prevalence of CMBs in patients with different TOAST classifications was large artery atherosclerosis(54.29%), small-artery occlusion(64.15%), cardioembolism(40.43%), stroke of other determined etiology(33.33%), stroke of undetermined etiology(38.46%), and the difference was statistically significant(χ2=12.206, P=0.016). The prevalence of CMBs in patients with different OCSP classifications was total anterior circulation infarcts(43.75%), partial anterior circulation infarcts(51.19%), posterior circulation infarcts(49.18%), lacunar infarcts(67.53%), and the difference was statistically significant(χ2=8.944, P=0.030). The severity of CMBs in patients with different TOAST classifications was large artery atherosclerosis[mild(55.26%), moderate(26.32%), severe(15.79%)], small-artery occlusion[mild(25.00%), moderate(33.82%), severe(41.18%)], cardioembolism[mild(57.89%), moderate(26.32%), severe(15.79%)), stroke of other determined etiology[mild(50.00%), moderate(33.33%), severe(16.67%)], stroke of undetermined etiology[mild(60.00%), moderate(20.00%), severe(20.00%)], and the difference was statistically significant(Fisher exact test, P=0.025). The severity of CMBs in patients with different OCSP classifications was total anterior circulation infarcts[mild(57.14%), moderate(28.57%), severe(14.29%)], partial anterior circulation infarcts[mild(52.50%), moderate(32.50%), severe(15.00%)], posterior circulation infarcts[mild(50.00%), moderate(33.33%), severe(16.67%)], lacunar infarcts[mild(25.00%), moderate(32.69%), severe(42.31%)], and the difference was statistically significant(Fisher exact test, P=0.023). Conclusion The prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction are variable.The prevalence of CMBs in small-artery occlusion and lacunar infarcts are the highest and give first place to severe CMBs(number of lesions≥10). We should pay attention to these two stroke classifications by early recognition and taking targeted clinical strategies. Key words: Stroke; Cerebral infarction; Cerebral hemorrhage; Prevalence; Magnetic resonance imaging

Microbleed prevalence and burden in anticoagulant-associated intracerebral bleed.

Prior studies suggest an association between Vitamin K antagonists (VKA) and cerebral microbleeds (CMBs); less is known about nonvitamin K oral anticoagulants (NOACs). In this observational study we describe CMB profiles in a multicenter cohort of 89 anticoagulation‐related intracerebral hemorrhage (ICH) patients. CMB prevalence was 51% (52% in VKA‐ICH, 48% in NOAC‐ICH). NOAC‐ICH patients had lower median CMB count [2(IQR:1–3) vs. 7(4–11); P < 0.001]; ≥5 CMBs were less prevalent in NOAC‐ICH (4% vs. 31%, P = 0.006). This inverse association between NOAC exposure and high CMB count persisted in multivariable logistic regression models adjusting for potential confounders (OR 0.10, 95%CI: 0.01–0.83; P = 0.034).

Association between cerebral microbleeds and hypertension in the Swedish general population "Good Aging in Skåne" study.

Cerebral microbleeds (CMB) on MRI are frequent in healthy aging individuals but precede ischemic and hemorrhagic stroke and dementia. Different etiologies have been suggested for nonlobar CMB, which have a stronger connection to hypertension (HT) than do lobar CMB. This study aimed to investigate the prevalence of CMB and the association between nonlobar/lobar CMB and different blood pressure (BP) and HT treatment conditions in a longitudinal, population‐based cohort of the Good Aging in Skåne (GÅS) study. White matter hyperintensities (WMH), CMB, atrophies, and infarctions were identified with brain 3T MRI, and BP parameters were examined in 344 randomly selected subjects between 70 and 87 years old. CMB were observed in 26% of the whole cohort, increasing from 19% of subjects in their 70s to 30% of those over 80 years of age. Of these subjects, 38% had multiple CMB, and 59% had a lobar localization. CMB were associated with severe confluent WMH (odds ratio = 7.02; 2.16‐18.84). Increasing age, being male, and having HT, impaired cognition, or a history of angina pectoris were associated with CMB. Both lobar and nonlobar CMB were associated with HT. Nonlobar CMB were particularly associated with increased BP, pulse pressure, controlled HT, and uncontrolled HT. After controlling for sex and HT, age was no longer a risk factor for CMB In conclusion, sex and HT are the major risk factors for CMB, especially nonlobar CMB, which suggests stricter implementation of recommended guidelines for HT treatment in the elderly.

SAT-064 PRESENCE OF DEEP BRAIN CEREBRAL MICROBLEEDS IS A STRONGER PREDICTOR OF INTRACEREBRAL HEMORRHAGE THAN LOBAR CEREBRAL MICROBLEEDS IN HEMODIALYSIS PATIENTS

Cerebral microbleeds (CMBs) are seen as small, round hypointense lesions on gradient-echo T2*-weighted magnetic resonance imaging (MRI). Previous studies have shown that CMBs occur more frequently in patients with ischemic stroke (IS), transient ischemic attack (TIA), and spontaneous intracerebral hemorrhage (ICH). CMBs may also predict a future risk of spontaneous ICH and IS in patients after ICH, IS, and transient ischemic attack, as well as in stroke-free individuals. In hemodialysis (HD) patients, a high prevalence of CMBs and the presence of CMBs have also been found to be independent and strong predictors of ICH.

Prevalence and Risk Factors of Cerebral Microbleeds in Patients with Nonvalvular Atrial Fibrillation: An Enhanced T2*-Weighted Angiography Imaging Study

Background/Aims: Cerebral microbleeds (CMBs) may predict the occurrence of intracerebral hemorrhage (ICH). Warfarin use may cause ICH. It is still controversial whether warfarin increases CMBs in atrial fibrillation (AF) patients. The study aimed to investigate the prevalence of CMBs and risk factors in AF patient population. Methods: This single retrospective center study included 113 patients with nonvalvular atrial fibrillation (NVAF) who were on outpatient treatment. CMBs were counted using 3D-enhanced T2*-weighted angiography (ESWAN) imaging. We compared clinical and radiological data between patients who used warfarin and not used warfarin with univariate analysis. The associations between clinical and radiological data and CMBs in NVAF population were analyzed with multivariate linear regression analyses. Results: Among 113 NVAF patients, CMBs were found in 33 (29.2%) patients; there were 53 patients who used warfarin for thromboembolism prevention and 60 patients with similar demographic features who did not use warfarin. CMBs on ESWAN MRI showed no significant difference between the 2 groups (p = 0.061). Patients with CMBs were older than patients without CMBs (p = 0.046), and the frequency of smokers (p = 0.028), hypertension (p = 0.029), previous ICH (p = 0.000), and leukoaraiosis (p = 0.020) in patients with CMBs were significantly higher than patients without CMBs. In multivariate linear regression analyses, previous ICH (β = 1.438, p = 0.000), age (β = 0.082, p = 0.000), hypertension (β = 0.956 p = 0.003), warfarin treatment (β = 0.849, p = 0.006), and smokers (β = 0.920, p = 0.016) were positive linear predictors of CMBs number levels in NVAF patients. Conclusion: The present data demonstrated that CMBs were associated with age, hypertension, warfarin treatment, smoking, and a history of ICH. We also found neither CHA2DS2-VASc score nor HAS-BLED score was associated with CMBs in patients with NVAF.

Cerebral Microbleeds are Associated with Postural Instability and Gait Disturbance Subtype in People with Parkinson’s Disease

Objectives: The motor symptoms of Parkinson’s disease (PD) vary among patients and have been categorized into 3 subtypes: tremor dominant, akinetic rigidity, and postural instability and gait disturbance (PIGD). Cerebral microbleed (CMB) is prevalent in people with PD and is associated with some nonmotor symptoms. The present study investigated the association between CMB and the motor subtypes of PD. Materials and Methods: From 2009 to 2017, medical records and brain magnetic resonance imaging (MRI) reports of 134 Taiwanese people with early- and mid-stage PD were reviewed. CMBs were quantified according to the Microbleed Anatomical Rating Scale through susceptibility-weighted MRI. Motor subtypes were determined by medical chart review. Student’s t test and multivariable logistic regression were used to analyze the association between the motor subtypes and CMB. Statistical analyses were performed using SPSS 19.0. Results: Overall, 72 (53.7%) participants were women with a mean age of 69.5 ± 9.8 years. The prevalence of CMB was 33.6%, and lobar, deep, and infratentorial CMBs comprised 21.6, 19.4, and 11.9% of cases, respectively. PIGD subtype PD was associated with a significantly higher prevalence of any CMB as well as deep or lobar CMB. After adjustment for age and sex, the PIGD subtype was significantly positively associated with the presence of any, deep, and white matter (WM) and thalamic CMB. Conclusions: CMB was prevalent in Taiwanese people with early- and mid-stage PD, especially the PIGD subtype. Deep, especially thalamic and WM, CMBs exhibited the highest association with the PIGD subtype.

Risk Factors for and Clinical Relevance of Incident and Progression of Cerebral Small Vessel Disease Markers in an Asian Memory Clinic Population.

Cerebral small vessel disease (SVD) is one of the major contributors to cognitive impairment and dementia. However, data on the incidence and progression of SVD in an Asian population are lacking. The present study aims to investigate the incidence, progression, associated risk factors, and clinical relevance of SVD in a memory clinic setting. A prospective case-control study, where 346 patients underwent repeated brain MRI with a mean interval of 24.5 months, accessing white matter hyperintensities (WMH), lacunes and cerebral microbleeds (CMBs). Severity of cognitive impairment was assessed using Clinical Dementia Rating scale and change in clinical diagnosis. Data on demographics, vascular risk factors, and clinical history were collected at baseline. The prevalence of significant WMH (Fazekas ≥2) was 56.6% at baseline which progressed to 59.0% at follow-up. Overall prevalence of CMBs increased from 42.2% to 47.4% (9% new cases) and lacunes increased from 31.8% to 33.2% (2.1% new cases). Hypertension was associated with WMH progression (OR: 1.78, 95% CI: 1.01, 2.99) and increasing age was associated with incident CMBs (OR: 1.04, 95% CI: 1.01, 1.08). Moreover, the use of lipid-lowering medications decreased the incidence of lacunes (OR: 0.15, 95% CI: 0.04, 0.61). The major risk factor for incident SVD was baseline SVD lesion load. WMH progression was associated with increased severity of cognitive impairment (OR: 1.95, 95% CI: 1.16, 3.23). Vascular risk factors and baseline severity of SVD lesion load were associated with progression of SVD. Furthermore, WMH progression was linked with increased severity of cognitive impairment. Future studies should be aimed to slow cognitive deterioration by preventing SVD related brain damage by targeting vascular risk factors.

Abstract 123: Underlying Pathologic Differentiation With Cerebral Microbleeds in Embolic Stroke of Undetermined Source

Background and purpose: The embolic stroke of undetermined source (ESUS) was introduced and expected the efficacy of anticoagulant. However, a large-scale clinical trial failed to reveal the superiority of rivaroxaban to aspirin. The heterogeneous pathology of ESUS may be a cause of this discrepancy. The prevalence of cerebral microbleeds (CMBs) is different among subtypes of ischemic stroke. In this study, we aimed to differentiate the underlying pathology of ESUS throughout analyzing CMBs. Methods: Acute ESUS patients who were admitted to our hospital between April 2014 and December 2016 were studied. In addition, findings of brain MRI including T2*-weighted imaging and transesophageal echocardiography (TEE) were collected to assess covert pathology of ESUS. Results: Of a total 1612 acute ischemic stroke patients, 221 (13.7%, 78 women, 71.9±12.7 years) met the criteria of ESUS and underwent brain MRI and TEE. Of these, 94 had CMBs (the CMB group) and 127 did not (the non-CMB group). The CMB group was more aged (75.3 ± 9.5 vs 69.5 ± 14.1 years, p=0.0006), more male (74.5% vs 57.5%, p=0.0104), and more hypertensive (94.7% vs 69.3%, p&lt;0.0001) than the non-CMB group. Brain MRI revealed broader deep white matter hyperintensity (Fazekas grade 2-3; 61.7% vs 27.6%, p&lt;0.0001) and periventricular hyperintensity (Fazekas grade 2-3; 77.7% vs 34.7%, p&lt;0.0001) in the CMB group. TEE more frequently showed aortic complicated lesions of arch (thickness ≥4mm or with ulceration or mobile components; 50.0% vs 20.5%, p&lt;0.0001) in the CMB group. Covert atrial fibrillation was detected less frequently in the CMB group (10.6% vs 21.3%, p=0.0448) during hospitalization. In a multiple logistic regression analysis, hypertension (OR 6.90, 95%CI 2.51-22.77, p&lt;0.0001), deep white matter hyperintensity (2.29, 1.03-5.10, p=0.0428), periventricular hyperintensity (3.66, 1.63-8.49, p=0.0016), aortic complicated lesion (2.12, 1.03-4.41, p=0.0416), and atrial fibrillation (0.33, 0.12-0.80, p=0.0137) were independently associated with the CMB group. Conclusions: Because ESUS patients with CMBs more frequently had aortic complicated lesion and less frequently had atrial fibrillation than those without, CMBs may have a potential to discriminate underlying pathology of ESUS.

Abstract TP206: Prevalence and Predictors of Cerebral Microbleeds Among Racial Minorities With Ischemic Stroke and Transient Ischemic Attack

Background: Cerebral microbleeds (CMB) are associated with dementia and stroke. CMB are attributed to cerebral amyloid angiopathy (lobar CMB), and hypertensive angiopathy (deep CMB). Racial minorities (RM) have a higher prevalence and poorer control of vascular risk factors, thus CMB may differ in prevalence and distribution in RM. We determined the prevalence, burden and vascular risk factors of CMB across racial groups in patients with stroke and transient ischemic attack, and CMB influence in short term outcomes. Methods: We included 2001 consecutive (year 2009-2018) patients with a readable T2*gradient-echo MRI sequence. CMB rating followed standardized guidelines and grouped topographically into lobar, deep or infratentorial. Race was self-reported based on U.S. census procedures and categorized as White, Black or Other racial groups (ORG). Univariate analyses were done to compare vascular risk factors between CMB groups, and multivariate logistic regression analyses were used to relate CMB and short term functional (modified Ranking scale score &lt;3 vs. higher) and adverse hospital outcomes (pneumonia, UTI, DVT, death), across racial groups. Results: We observed CMB in 679 (34%) patients. The respective distribution in lobar, deep and infratentorial regions were: Whites (n=174; 67.2%, 20.7% and 12%); Blacks (n=374; 53%, 28.4% and 18.5%); ORG (n=131; 45.5%, 25.3% and 29.3%). Blacks and ORG with CMB were younger than Whites (66 and 66 vs 70; p&lt;0.01); and had higher prevalence of diabetes (44% and 41% vs 28%, p&lt;0.01). Blacks had higher prevalence of previous stroke when compared with Whites (36% vs 27%, p&lt;0.05). Patients with 10+ CMB, compared with no CMB and 1-9 CMB, had higher in-hospital pneumonia (8% vs 2.1% and 2.4% respectively; p=0.02) and were less likely to have mRS 0-2 at discharge (44.8% vs 55.3% and 48.7%; p=0.06). No difference was observed in mortality and other hospital adverse events. Conclusion: Racial minorities had higher proportion of CMB in non-lobar regions, suggesting that RM are more likely to have hypertensive angiopathy. RM with CMB were younger and differed in several risk factors compared to Whites. High CMB burden affected adversely outcomes. Further studies are needed to better characterize the clinical impact of CMB in RM.

Abstract TP186: Impact of Long-term Left Ventricular Assist Device Support on Human Brain: A Case-control Study Using MRI

Introduction: Left ventricular assist device (LVAD) implantation improves the prognosis of patients with severe heart failure; however, the potential impact of long-term LVAD support on the brain remains unclear. The aim of this case-control study was to examine the characteristics of brain MRI in patients after long-term LVAD support. Methods: We retrospectively reviewed consecutive adult patients who underwent continuous-flow LVAD implantation in our hospital from 2010 to 2017, and those who underwent brain MRI after successful LVAD explantation were enrolled in this study. Age- and sex-matched control subjects (1:1) were selected from a pool of normal subjects who underwent MRI examination for screening purposes. The number and location of cerebral microbleeds (CMBs) and superficial siderosis, and the severity of white matter hyperintensity (WMH) and cerebral atrophy were compared between LVAD patients and controls. Results: We enrolled 49 LVAD patients and 49 controls. In LVAD patients, cardiomyopathy (84%) was the most common underlying heart disease. Heart transplantation was performed in 46 patients (94%) and 3 removed LVAD due to myocardial recovery. The median age was 41 years (range 19-66), and the median LVAD support time was 32 months (4-52). Nineteen patients developed symptomatic stroke (10 ischemic and 10 hemorrhagic) during LVAD support. Except for one, almost all (98%) LVAD patients had one or more CMBs, and the number of CMBs was much higher in the LVAD patients (mean, IQR: 7, 3-11 vs 0, 0-0: p&lt;0.001) than controls. Superficial siderosis was positive in 15 (31%) of LVAD patients, but not in controls. The severity of WMH was significantly higher both in deep subcortical (p=0.01), and periventricular region (p=0.04) than controls. In quantitative analyses of cerebral atrophy, bicaudate ratio (0.105±0.023 vs 0.089±0.019: p&lt;0.001) and cella-media index (0.160±0.033 vs 0.141±0.024: p&lt;0.001) were significantly higher in LVAD patients than controls. Conclusions: Patients after long-term LVAD support showed a high prevalence of CMBs and superficial siderosis, and more severe WMH and cerebral atrophy compared to age- and sex-matched controls. Long-term LVAD support may cause cerebral small vessel disease.

Pre-treatment cerebral microbleeds and intracranial hemorrhage in patients with ischemic stroke receiving endovascular therapy: a systematic review and meta-analysis.

Predicting the risk of intracranial hemorrhage (ICH) is an important aspect for improving the efficacy and safety of endovascular therapy (EVT). We intended to perform a systematic review and meta-analysis to show whether pre-treatment cerebral microbleeds(CMBs) were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT. We searched PubMed, EMBASE, Web of Science and Cochrane Library from their dates of inception to December 18, 2018, and also manually searched reference lists of relevant articles. Cumulative prevalence of CMBs and ICH was calculated. Relative risk and 95% confidence interval (CI) were calculated for the incidence of ICH in patients with CMBs versus those without after EVT. Four studies involving 598 patients were included. The pooled prevalence of CMBs was 18% (95% CI 15-21%) and the pooled prevalence of ≥ 5 CMBs was 1% (95% CI 0-2%). The pooled incidence of ICH was 29% (95% CI 8-49%) in all patients, 25% (95% CI 5-45%) in those with CMBs and 29% (95% CI 8-50%) in those without CMBs. The pooled relative risk of ICH was 0.90 (95% CI 0.65-1.25, P = 0.528; I2 = 0%, P = 0.949) in patients with CMBs versus those without CMBs. There is no evidence that pre-treatment CMBs were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT.